Sunday, February 04, 2007

(HealthDay News) -- As the U.S. fashion season kicks off Friday in New York City, the headline-grabbing controversy over dangerously thin models will link arms with haute couture on the runway.

The furor began in earnest last year with the deaths of two young models from anorexia nervosa and has since escalated, prompting fashion-show bosses in Europe to ban girls under a certain body mass index from working the shows.

In mid-January, the Council of Fashion Designers of America (CFDA) issued its own "Health Initiative," stressing voluntary measures to "create an atmosphere that supports the well-being of these young women."

But that may not be enough to protect models -- and the millions of girls and women who emulate them, critics charge.

Too often, "guidelines are things that people just hang on a wall," said Lynn Grefe, chief executive officer of the National Eating Disorders Association.

While she's pleased that the CFDA has "opened a dialogue" on the issue, Grefe said she's waiting to see how these voluntary rules get implemented.

"Right now, I'm not sure how they are going to handle it if they have an anorexic girl in the shows," Grefe said. Given that most eating-disorder sufferers hide the problem, "How are designers going to know about it? And who's going to tell the girl?" she said.

The issue gained renewed prominence with the eating-disorders deaths in 2006 of two young models -- Luisel Ramos, of Uruguay, and Ana Carolina Reston, of Brazil, who was 5 feet 8 inches tall and weighed 88 pounds when she died. Reston reportedly lived on a diet of apples and tomatoes in the weeks before her death.

The outcry over these deaths led to a move in September by government officials in Madrid to ban models with a body-mass index (BMI) of less than 18 from performing in city-sponsored fashion shows.

Milan followed suit, with a similar ordinance passed by government officials last month to restrict runway models to BMIs of 18.5 or more. (For reference, a 5-foot-9 woman with a BMI of 18.5 would weigh 125 pounds). Italian designers have also agreed to demand that all models submit medical proof that they don't suffer from an eating disorder as a condition to work.

The CFDA, which recently appointed designer Diane von Furstenberg as its president, hasn't gone that far. Instead, the group is asking the fashion industry to get better educated about the signs of eating disorders, to have models who are "identified" as having a disorder seek medical help, to ban models under the age of 16 from all runway shows, and to have healthy snacks available backstage at all times.

The council does not advocate any BMI cutoff for runway models. According to its Jan. 12 statement, the group's initiative "is about awareness and education, not policing. Therefore, the [CFDA] committee is not recommending that models get a doctor's physical examination to assess their health or body mass index to be permitted to work."

A representative of the CFDA said the group isn't offering further comment on the issue until after a public meeting in New York City on the problem, scheduled for Feb. 5.

But, BMI-linked policing of future New York shows may still come. On Jan. 31, a Democratic New York state assemblyman, Jose Rivera, said he would propose that a state advisory board be formed to craft guidelines to prevent eating disorders among models and performers under the age of 18. The measure may get support from the state Senate's majority leader, Republican Joseph Bruno, who last year revealed that his granddaughter suffers from anorexia nervosa.

New York City councilwoman Gale Brewer has also said that she plans to introduce a resolution on Friday to keep models with BMIs under 18.5 off the runways. "Women are encouraged to mutilate their bodies in the industry," Brewer told the New York Sun on Thursday.

"I feel the new [CFDA] guidelines really fell short," said Dr. Harry Brandt, director of the Center for Eating Disorders at Sheppard Pratt Health System in Towson, Md. His clinic sees more than 800 inpatients a year and treats thousands more for anorexia and bulimia on an outpatient basis.

"I believe that within the industry there has been an implicit encouragement of dramatic measures to maintain a certain body weight for models," he said. "The fashion industry needs to take steps to ensure the health of their employees and, in a broader societal context, to take appropriate measures to see to it that we are providing realistic images to girls."

Images in fashion and gossip magazines of ultra-thin models and celebrities do have an impact on girls' self-image, Brandt said. "We see it in our work with patients on a daily basis," he said. "Patients describe the intense pressure they feel to be thin, to be considered successful and attractive in our culture."

According to the National Eating Disorders Association (NEDA), more than 10 million American girls and women may be affected by eating disorders such as anorexia or bulimia, which carry the highest death risk of any psychiatric illness. And a 2000 British study drew a strong link between women viewing rail-thin models in magazines and an increased tendency for eating disorders.

One fashion industry insider agrees these images can do harm.

"The majority of women look at magazines, and they do not see themselves reflected," said Emme, a plus-size supermodel who made fashion history in the 1990s as the first full-figured model ever awarded a major cosmetics contract (Revlon). She's also a long-time NEDA ambassador, calling for more industry action on eating disorders.

The New York-based model said much more needs to be done to empower young models to retain control of their own bodies. "They are so impressionable, and you don't know where these pressures are coming from," Emme said. While she does not support a BMI cutoff, she does support stronger industry self-regulation. "I want us to say, 'That is too thin, and, no, you will not walk in my show,' " she said.

Emme said she was shocked recently by photos sent to her of especially emaciated models appearing in a glossy fashion layout. "I was horrified to look at these pictures," she said, describing the models as "bags of bones dressed in haute couture."

"I was astonished, too, that these girls were booked, that there were obviously people around to see them, that they had to be fitted for the clothes. So, all of this had to be approved," Emme said. "And these girls are skeletal."

Some skinny models born that way, editor says

Of course, not every model has an eating disorder, and the fashion world does have its defenders. Memsor Kamarake, a former stylist and modeling agency executive, is now fashion director at Vibe magazine. Speaking from the Paris runway shows this week, he said he's against any BMI threshold for models.

"At the end of the day, just making sure that models are healthy should be the first priority," Kamarake said. "I think that when we get into this territory of 'this certain body type is right, this isn't,' that it opens the door to something a bit scary."

He also believes that many super-thin models are genetically geared to stay skinny and healthy. He cited the example of a model used in a recent Vibe photo shoot, a willowy 16-year-old named Chanel Iman."I saw her on the set, and she had a plate of food and ate all day," Kamarake said. "We actually were teasing her about it, but she said, 'I eat like this all the time.' "

So, Kamarake added, "if [a model] has accomplished something, why should we not include her? Because her body type makes people uncomfortable?"

But the Center for Eating Disorders' Brandt called that argument "a cop-out."

"Yes, there are exceedingly thin people who are perfectly healthy and normal -- I'm the first to acknowledge that weight falls on a bell curve of distribution," Brandt said. "But the reality is that, in the modeling industry, there are case examples of very famous models who've come forward only later to say, 'I had to starve myself to maintain my appearance.' "

That's why the CFDA's pledge to help models who are "identified" as having a problem won't work, Brandt said. "Nobody goes to their employer and says, 'Oh, by the way, I have a significant health problem, and I probably shouldn't be doing this job.' That's just not the way it works."

All of this means that models, rather than clothes, could face the toughest scrutiny during the New York shows, which conclude Feb. 9.

"I really hope that this is not just a case of 'let's satisfy the public by saying we are going to educate people,' " Emme said. "I want to know what else they are going to do. We are going to find out next week where we are with designers really self-regulating."

But Kamarake appeared dubious about industry-wide change.

"I can't imagine a designer who's doing shows now who isn't thinking about the controversy," he said. But other heated issues have also come and gone, he noted.

"Remember the whole controversy about fur use? I'm sure designers think about it, but there's still a lot of lynx around. There's still a lot of chinchilla out there."

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